Call the Shots on Travel Vaccines

As COVID-19 pandemic-related restrictions loosen and international travel reopens, pharmacists are in an optimal position to provide patients with information about travel vaccines.

Being vaccinated protects both travelers and the individuals with whom they come in contact during their time abroad and their return home.¹
Many countries have a range of recommended, required, and routine vaccines for travelers. Yet results of a survey of 1254 individuals departing the United States for international destinations found that up to 80% of respondents did not have a health consultation before traveling.^2,3

The most common reason for declining a pretravel evaluation was a “lack of concern about health problems related to the trip,” according to the survey results.²

Pharmacists can address this lack of concern and other issues related to travel vaccines by assessing travelers’ needs, evaluating specific destination recommendations or requirements, and providing travel medicine resources for additional information.

Assessing Travel Vaccination Needs

Each patient’s vaccination needs vary depending on the destination, trip duration, and type of travel.^4-6 Table 1^1,4,6 provides questions that pharmacists should ask to assess a traveler’s particular requirements and the rationale for doing so.

Evaluating Recommended, Required, and Routine Vaccines

Pharmacists should take the following steps when evaluating a traveler’s potential vaccine needs:

For recommended or required vaccines: Determine the recommendations and requirements specific to the traveler’s destination. Some diseases eradicated in the United States still exist in other countries, necessitating vaccination.⁶ Many countries in tropical climates require the yellow fever vaccine. Some also require proof of meningococcal meningitis and/or polio vaccination.⁴ Table 2^3,4 lists possible vaccines that are recommended and/or required by international destinations. The CDC provides an interactive tool at gten.travel/prep/prep to help identify a patient’s travel risks and needs based on destination.

For routine vaccines: Review routine immunizations that the patient has already received.⁷ Some routine childhood vaccines require repeat doses to provide an effective level of immunity, which might otherwise wane over time.^3,6 Pharmacists should determine whether a traveler is up to date on all appropriate routine vaccinations and offer or suggest booster doses if needed. In particular, hepatitis A and B vaccines are recommended for all travelers.^3,4 Table 3⁸ lists available routine vaccinations for adults as specified by the CDC. Note that some vaccines may have age or indication restrictions.

Providing Travel Medicine Resources

Pharmacists also can direct travelers to resources provided by the CDC for more information. These resources include:

• Health notices (wwwnc.cdc.gov/travel/notices)
• Health recommendations by destination (wwwnc.cdc.gov/travel/destinations/list)
• Travel vaccine clinic locator (wwwnc.cdc.gov/travel/page/find-clinic)

Lisa Ruohoniemi, PharmD, is a pharmacist at LewisGale Hospital Montgomery in Blacksburg, Virginia.

REFERENCES

1. Vaccines for travelers. US Department of Health & Human Services. Updated April 29, 2021. Accessed August 6, 2021. https://www.hhs.gov/immunization/who-and-when/travel/index.html
2. LaRocque RC, Rao SR, Tsibris A, et al. Pre-travel health advice-seeking behavior among US international travelers departing from Boston Logan International Airport. J Travel Med. 2010;17(6):387-391. doi:10.1111/j.1708-8305.2010.00457.x
3. Freedman DO, Chen LH, Kozarsky PE. Medical considerations before international travel. N Engl J Med. 2016;375(3):247-260. doi:10.1056/NEJMra1508815
4. Everything you need to know about travel vaccines. International Association for Medical Assistance to Travellers[CB1]. Updated December 11, 2020. Accessed August 7, 2021. https://www.iamat.org/everything-you-need-to-know-about-travel-vaccines-
5. Pre-travel quick guide. CDC. Updated December 4, 2019. Accessed August 6, 2021. https://wwwnc.cdc.gov/travel/page/pre-travel-guide
6. Vaccine preventable diseases and vaccines. World Health Organization. In: International Travel and Health. 2019. Updated July 7, 2020. Accessed August 9, 2021. https://www.who.int/publications/m/item/international-travel-and-health-chapter-6---vaccine-preventable-diseases-and-vaccines
7. Routine vaccines. CDC. Updated November 26, 2019. Accessed August 6, 2021. https://wwwnc.cdc.gov/travel/page/routine-vaccines
8. Recommended adult immunization schedule for ages 19 years or older, United States, 2021. CDC. Updated February 12, 2021. Accessed August 9, 2021. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fschedules%2Feasy-to-read%2Fadult.html